Renal (or kidney) pathology remains as a somewhat overlooked subspecialty in pathology. While the global research and pharmaceutical industries continue to revolve, rightfully, around oncology – enabling us to whisper, “we fear much less” – chronic kidney disease (CKD) remains in the shadows.
CKD is marked by numerous comorbidities and a wide spectrum of physical and mental complications. Patients with the condition are too often underdiagnosed. Pushed to the periphery of basic healthcare, especially where specialized centers are absent. According to the US Centers for Disease Control and Prevention, approximately 14 percent of the US population has CKD – and 9 out of 10 affected individuals are unaware of their condition.
As a renal pathologist, I recall diagnosing renal biopsies with incidental findings of advanced-stage glomerular diseases in patients referred after routine check-ups and urinary abnormalities detection. On this journey in a unique and “niche” subspecialty, I’ve been fortunate to learn from giants in the field. I invest eagerly in rare and costly renal pathology books and I’m also proud to provide free digital consultations for my father’s patients in Ukraine – even from my home in Italy (my father is a “rock star” professor of nephrology back home).
Yet, even among my most brilliant and experienced pathology colleagues, I sometimes feel the absence of a strong nephropathology network – a shoulder to lean on. Accurate diagnosis of glomerulonephritis is vital for treatment decisions, often involving potent therapies that are still frequently overused or underutilized in clinical practice.
And I confess: I struggle with almost every diagnosis. Because even though we typically operate “behind the glass,” our responsibility is clear. There is always a human being on the other side. And the things I state in my medical report will bear the consequences to their choice of treatment, healing, and quality of life.
There is more to it: renal pathologists are rare, as mentioned. That said, there is little to no chance a patient’s case would be taken to second opinion if I don’t do it myself. My errors, if committed, may come at a great cost to a patient, in many senses.
Let’s also consider the preanalytical challenges. I’ve trained as a visiting pathologist in numerous laboratories worldwide. Some institutions are equipped with dialysis and transplant departments, skilled teams, immunofluorescence/immunohistochemistry, and electron microscopy. Sadly, many medical centers worldwide are not endowed of this luxury.
In Kyiv, our lab handles only a few kidney biopsies each week. We don’t rely on large commercial labs due to time and cost constraints. We (traditionally) rely on ourselves in manual tissue processing and staining.Still, we remain one of Ukraine’s most important referral centers for kidney biopsies, a fact that fills me with pride.
But let’s be honest: if not for the war, how quickly would we find a sponsor to buy a portable slide scanner? Who would replenish the antibody supplies? Who would pay a technician for just one or two cases a week? If renal pathology is considered rudimentary in so many European centers, what hope do “developing countries” have?
While our environment inevitably increases DNA damage and the risk of disease, awareness and lifestyle still matter – especially for conditions like obesity, type 2 diabetes, and CKD. We need to focus more on public education around CKD: its risks, signs, and preventive measures.
I would be thrilled to see renal pathology take a more prominent role – both online and in real-world communities. The current outlook is sobering, and our expertise will only become more critical in the years to come.
Newsletters
Receive the latest pathology news, personalities, education, and career development – weekly to your inbox.
